Mentally healthy adults

  • Desired outcomes
  • Current evidence
  • Recommendations
  • Case studies
  • Equality and diversity
  • According to Health, Work and Wellbeing [external site], being in paid employment or unpaid work compared with being unemployed, is better for mental wellbeing and helps protect against mental health problems.

    Paid employment may not only provide financial security, but also contribute to feelings of self-worth through increased opportunities for social interaction and engagement, feelings of control, a sense of purpose, as well as personal identity.

    The benefits of paid and unpaid work are reliant on the nature and quality of the work, the culture within the workplace, as well as the way it is organised.

    A poor work environment – lack of support, unclear or inconsistent information from supervisors, unrealistic or high demands, low levels of control, and insecurity – can have negative effects on both employees and employers.

    According to the Scotland Office [external site] and the Scottish Government [external site], around 70% of the Scottish population are in employment. Workplaces can therefore play a highly effective role in mental health improvement by providing mechanisms for staff that may need support.

    Organisations need to be active in promoting mental wellbeing for all employees, reducing work-related causes of mental health problems and improving the quality of life of those experiencing mental health problems.

    Mental health improvement in the workforce requires both action at an individual level – providing opportunities for staff to look after their own mental wellbeing – and organisation-focused interventions, introducing policies and practices to improve working conditions and the physical working environment.

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    Desired outcomes

    • Increased understanding of mental health improvement in the workplace.
    • Increased mental wellbeing at work.
    • Reduced levels of people suffering stigma and discrimination linked to mental health.
    • Reduced work-related causes of mental health problems.
    • Reduced number of employees absent from work due to mental health problems.
    • Improved quality of life for those experiencing mental health problems.
    • Increased employability of those experiencing mental health problems that are out of work.


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    Current evidence

    Informed by reviews of effectiveness evidence, NICE have produced public health guidance on promoting mental wellbeing at work. NICE public health guidance 22: Promoting mental wellbeing through productive and healthy working conditions: guidance for employers [PDF: 261kb] made five recommendations with a number of action points.

    These actions should help all employers, irrespective of the size of their business or organisation and whether they are in the public, private, or voluntary sectors, to create a mentally healthy workplace. The guidance cites evidence to the effect that people in lower paid jobs are more likely to experience poor working conditions, such as lack of control of their workload, lack of job security, limited support, and exposure to physical hazards. It suggests that improvements in the quality of work and working conditions may consequently help to reduce health inequalities.

    The guidance also refers to growing diversity of the workforce, including a significant increase in women in part-time jobs, migrant workers and older employees, as having increased the potential for stress associated with discrimination and perceived injustice.

    The NHS Health Scotland Scottish Perspective on this guidance supported the action points subject, where appropriate, to adaptation to fit Scottish organisational arrangement. The full recommendations for Scotland can be found on the Health Scotland website [external site].

    Also informed by reviews of effectiveness evidence, the Foresight Project called Mental Capital and Wellbeing [external site] suggests actions that could help workers to enhance their wellbeing in the workplace, whilst preserving, or even enhancing, efficiency and productivity:

    • Assess work environments for impact on mental capital and wellbeing.
    • Better diagnosis and remediation of underlying work related stress.
    • Develop more sophisticated ways of flexible working.
    • Improve managerial competence in providing healthy workplaces.
    • Raise the profile of mental health at work.

    A range of training and guidance on good practice in the workplace are available on the Healthy Working Lives website [external site].

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    There are many recommendations included in the current evidence and policy and resources sections of the website. Improving the quality of life of those experiencing mental health problems can help ensure positive outcomes for employers and employees. Organisational change and good management practice can improve levels of job control thorough communication and participation in decision-making and problem solving. Increasing understanding about mental health problems at work is also important. Specific interventions that employers can undertake include guidance to self help management, early referral to workplace-based support and stress management, as well as supporting people back to work through primary care – for example through cognitive behavioural therapy (CBT). Employers should be able to demonstrate a comprehensive and integrated approach, including:

    • promoting the mental wellbeing of all employees
    • preventing work-related causes of mental health problems
    • retaining and supporting people in work when they develop or experience mental health problems
    • recruiting long-term unemployed people with mental health problems as part of their recovery
    • facilitating the return to work of people who currently have, or have experienced, mental health problems.

    Supportive employment practices include:

    • an ethos and culture that sets the tone for healthy relationships and good experiences at work
    • working practices that value and foster peer relationships
    • accessible and supportive management structures and relationships
    • policies and procedures to ensure good practice
    • flexibility and adaptation of role and workload to accommodate individuals
    • management of transitions and changes to support people moving into new roles or returning after absence.

    For more information on supportive employment practices, please visit the Centre for Mental Health website [external site].

    Employees have a responsibility to promote their own mental wellbeing and take action to protect against mental health problems. However, many of the factors influencing the health of staff are psychosocial, relating to the style of management and working culture.

    Mental wellbeing and mental health problems need to be addressed systematically both at an organisational and at an individual level.

    Workplaces can support individuals by providing information on positive steps for mental health improvement, and by:

    • promoting wellbeing through auditing work environments using the HSE's Management Standards
    • developing new and more sophisticated ways of flexible working
    • providing training for managers in mental health improvement
    • ensuring workplace policies consider mental health improvement
    • ensuring improved access to occupational health services.

    As service providers, individual members of local partnerships (for example, community planning or employability partnerships) should promote mentally healthy workplaces by:

    • providing support and resources to employers to promote mental wellbeing: for example, if an employer signs up for a Healthy Working Lives award, it's important to ensure they have contact details for local mental health improvement opportunities and lead contacts for information
    • taking action to improve understanding of the relationship between mental health and work: for example, the case should be made to employers for mental health improvement at work
    • providing services and support locally to help people with mental health problems to stay in work, enter the workforce or return to work
    • raising awareness of sections 25-31 of the Mental Health (Care and Treatment) (Scotland) Act 2003 [external site] with employability partnerships
    • ensuring that employment support services act on the evidence that placements and open employment with support are more effective than pre-work preparation
    • addressing stigma, discrimination and negative attitudes to mental health problems in the workplace.


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    Case studies

    Examples of work in Scotland to improve mental health in the workplace are included on the Scottish Centre for Healthy Working Lives website [external site], as well as in the case stidies section of this site. The Scotttish Centre for Healthy Working Lives provides support and guidance to employers on all aspects of occupational health, safety and wellbeing. In terms of mental health and wellbeing this includes:

    • the development and delivery of training for employers, covering promotion, prevention, retention and rehabilitation
    • the integration of mental health improvement within Scotland's Healthy Working Lives Award Programme
    • the development and support for a Mental Health and Wellbeing Commendation Award in the workplace
    • promoting the see me [external site] anti-stigma campaign and pledges for workplaces
    • developing resources for a range of workplaces including a tool box talk - Ahead for Health.

    Business costs of mental health problems

    • new statistics in 2011 revealed that stress was the most common cause of sickness absence for both manual and non-manual employees (CIPD, 2011)
    • mental health problems at work cost employers over £2bn a year. See What's it worth now? [PDF: 480kb].
    • at any one time, nearly 1 in 6 of their workforce is affected by a mental health condition such as depression or anxiety (McManus S, Meltzer H, Brugha T, Bebbington P and Jenkins R (2009) Adult Psychiatric Morbidity in England, 2007. London: NHS Information Centre)
    • 'presenteeism' accounts for 1.5 times as much working time lost as absenteeism and costs more to employers because it is more common among higher paid staff.
    • replacing staff that leave their jobs because of mental health problems costs £2.4bn a year. See The Centre for Mental Health website [external site].
    • about 35 per cent of people receive Incapacity Benefit because of mental health problems. See The Centre for Mental Health website [external site].
    • Health and safety statistics 2006/07 [PDF: 954kb] show that almost 30 million days were lost because of work-related illness. Stress, depression or anxiety accounted for 13.8 million days lost – 46 per cent of all reported illnesses.
    • as of February 2008, there were 271,400 people claiming Incapacity Benefit in Scotland. Between 60 per cent and 70 per cent of those cited mental health problems.
    • simple steps to improve the management of mental health in the workplace should enable employers to save 30 per cent or more of these costs – at least £8 billion a year (2007). See The Centre for Mental Health website [external site].


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    Equality and diversity

    The Annual Scottish Labour Force Survey 2004/05 [PDF: 502kb] found that 76 per cent of people with a mental health problem are unemployed. This figure is higher than for other groups with a disability or health condition.

    Mental health is affected by a wide range of factors, including inequalities or discrimination on the basis of gender, age, race, sexuality, disability or faith. For example, although we know that one in four people will be affected by a mental health problem in the course of a year, in general, rates of mental health problems are thought to be higher in minority ethnic groups than in the white population.

    Minority ethnic groups are, however, less likely to have mental health problems detected by a GP. See Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England [PDF: 206kb]

    It is crucial that employers consider the impact of policies, practices and procedures on everyone in the workplace in an inclusive way.


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